03-026 (4) GERRY SHATTUCK
29 Harrison Ave #1
Northampton, Massachusetts 01060
(413) 584-6265
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GERRY SHATTUCK
29 Harrison Ave#1
Northampton, Massachusetts 01060
(413) 584-6265
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GERRY SHATTUCK
29 Harrison Ave #1
Northampton, Massachusetts 01060
(413) 584-6265
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- GERRY SHATTUCK
---- `29 Harrison Ave#1
- Northampton;Massachusetts 01060
_ (413) 584-6265
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- DEPARTMENT• OF DUILDP\'G INSPECTIONS
212 plain Street ' Municipal Bu%ling
Northampton, Mass. 01(760
��torzla�lz�s
COM-PENSATION1 INSURANCE AFFMAVIT
(li��nscc.'E�rrulittcc)
"with a principal place 4; A-\Ik,busir�e.sslresidenee <lt
do lie---by ccltli}'' U11:� C ?ll'' 1�;.1i1S ;'.iiJ pC;i1.?ill S Ui pe.rlllflt, '.I1P.t
I am an employer providin- the followint, compensation cove.ra ,e "Cr my
eluployccs worl.-itlg on ulis iob.
(Lnsurana Corsp'ny) (Pelic;Nunnber) -- - - -(L�pir uoa Date)
O I and a sole proulictor, 'Teneral colltracior ur homeowner (circle one) and have iureu
the contractors listed beiove,;ti'1]0 ila`.'° iht folio,;,-�„ worke�S coinpen-?ilOfl pohCiCS:
CNI=p of COntI tGr) lII1SL':';; LOIP.n3a'rri Oh NUi11�r;) ;i::i iia]C`D3tC)
(Name of Contmc"or) .7,r<.nn gate)
(Name of Contractor) ;Inslirslc Lo:nl::fn�ii'ollc� Numt>�r) �,::r hate)
(Name of Contractor) (Insutan,t� Comt;;_ '.Tohcy Nun�2-r) I of aio: Date;
(r.tt�dt,d .imil cl;._ct...._ -->.- ... .r_...,- ....cKn;....., , .......:r., ..�i;�.�.__..._•)
( 1 m1i it SoIC 1)rOpI1 Ui 2il';1 ik1V no olle `;'.'cl k-lno fol mc,
( I am a hon e all C-i:: iii`rS 11
1i0TI,:plc_sc tic n`tiuc tYta;
Rol'aKVC thn throo units in u$ic�t'!ic u m tlw-E:-�.:.._>a,_r-utt<c•nt tlxreto ue n�d�e=rr�lly a�.r.ac:::::o he
car to an^mss the Mori cT�ec�:�za!ica G1,152�i! S �;ie:;by a homm>N�_r for e l c�tx cc V"":
legit ctatut of an omvloy� under t:.o Wo v4 't �n;wnatio t ALL
I underztand(llat i ocpy oft" to tl»IY.t>a.rtt—i of Indiu:riel Aa r ntr'Cflioo of I:::=u u>�o for 11x
eovcrage verification aad that f:lure to s<atrc covctmr_ut:-r:cc-ti-a 25A al i>ldl,152 can Ic d to tlx im sition o(auni�l pctsh:es
ooatisting of a ftne of up to S 1.50(100 of up to on-}cnr?_xl civil F"M1 ics in r fcx n of a Stcp AVc 0 and a
fiaa o(S 100.00 a day i:f_iml nr-
/ Fcc �atr'd'1 uw u,ly
G Pctrnit Tiumtrs ____-_ - _I1
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicaa—ble ❑
Flame of License Holder : C's �J
License Number
29 Harrison Ave#1 17A I zp,�
Address Northampton, Expiratio'n'Datef
(413) 584-6265
Signature Telephone/51�
Regtsterer3lmprbvem`ent.Contr`actor:: +�s,RSA Not Applicable ❑
Company Name Registratio N mber
29 Harrison Ave#1 __ _ (71 �
Address Expiration
(413) 584-6265 D to
Telephone
SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L, c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance o e building permit.
Signed Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings-of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official, on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 15') (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature _
SECTIONSDESC�RIpT10N OFPROPOSED WORK(check alf applicable)
w.4 .tea 3 a.x".ivrr33H5:rN.3.4(fmr„YN_9.6. Kn+kFz&ims R+a„ „ff._..wn.e3- i, .... -'b�'» ^.
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other [ )
Brief Description of Proposed Work: l7LZ-�rl `�_dFA
Alteration of existing bedroom Yes_ 40 Adding new bedroom Yes o
Attached Narrative o Renovating unfinished basement Yes v-' No
Plans Attached Roll 0. Sheet COY
sa�l'fiNew ho�`useandorraddition�: o�existing�housing ..com'p`let"e° thefollowi'ng:
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a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: — Number of Bathrooms A 1A,
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? _ Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION'-TO BE COMPLETED WHEN
OWN..EF�S AGENT O;R`CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Y1 as Owner/Authorized Agent
hereby declare that the state ents and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of 0 er Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by "Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L:
Rear
Building Height -Q f Z11
Bldg. Square Footage �� %
Open Space Footage %
(Lot area minus bldg&paved
arking) � --
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO V DON'T KNOW _ YES _
IF YES, date issued: _
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book _ _ Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained __Obtained _., Date Issued:__
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF-YES, describe size, type and location: —
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City of Northampton S t
r, Building Department C, b ctt
212 Main Street Se erg( a
Room 100 Wa e llW.e'
rl Northampton, MA 01060 ets
v �Ror{���13-587'.1240 Fax 413-587-1272 1 AlSii e,
�A OthersS
L::: APPLICATIONJO CONSTRUCT; ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section tobe completed by7offtCe
1.1 Property Address: �A
Map #�
Zone Overlay Distr ctt
Elm St. District %CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
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Name(Print Current Mailing Address:_ 5M-_--
_ Telephone
Signature ---
2.2 Aut r"'ed Agent:
Name(Print) Current Mailing Address:
Signature Telephone _.
SECTION 3''- ESTIMATED CONSTRUCTION COSTS'-
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) '�-stimated Total Cost of
Construction from 6
3. Plumbing _ Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature;
Building Commissioner/Inspector of Buildings Date
File#BP-2003-1068
APPLICANT/CONTACT PERSON Gerry Shattuck
ADDRESS/PHONE 40 Munroe St (413)584-6265
PROPERTY LOCATION 583 COLES MEADOW RD
MAP 03 PARCEL 026 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 14 X 14 SCREEN PORCH ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 058422
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO)RIOATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
'Permit from Elm Street C ssion
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
BP-2003-1068
GIs#: COMMONWEALTH OF MASSACHUSETTS
1 83,,p6 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-1068
Project# JS-2003-1697
Est. Cost: $11000.00
Fee: 555.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: R4 Gerry Shattuck 058422
Lot Size(sq. ft.): Owner: FLYNN JAMES
Zoning:RR Applicant: Gerry Shattuck
AT: 583 COLES MEADOW RD
Applicant Address: Phone: Insurance:
40 Munroe St (413) 584-6265
NORTHAMPTON MAO 1060 ISSUED ON.612103 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 14 SCREEN PORCH ADDITION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Feel e: Receipt No: Date Paid: Check No: Amount:
Building 6/2/03 0:00:00 3214 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
May 26 03 03: 00p
p . 3
-N0TE-
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
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TO: CITIMORTGAGE, INC . &
COMMONWEALTH LAND TI'T'LE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT T HAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED, I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY # 250167
—NOTE---
SURVEYOR'_i�(Vr-r THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
�N OF A41s —MORTGAGE LOAN INSPECTION PLAT-
�,tiP` sgcy NORTHAMPTON, MASSACHUSETTS _
2 RANDALL PREPARED FOR
E. JAMES P. FLYNN
S IZER
135032 SCALE: ] "=60 ' MAY 1 , 2002
RV HAROLD L. EATON AND ASSOCIATES, INC.
REGiSTERED PROFESSIONAL LAND SURVEYORS